Dr. Tedros Adhanom Ghebreyesus (00:00):
... animals. On that basis, WHO has recommended inclusion of the vaccine in a Phase 3 trial, which we hope to start as soon as possible. We do not know whether this vaccine is efficacious against Bundibugyo disease in humans. The Phase 3 trial is the best way to ensure a safe and effective vaccine is available as soon as possible for this and future outbreaks. We call on all partners to support and accelerate this trial. At the same time, we're moving rapidly to generate evidence on treatments. The WHO-sponsored PARTNERS trial has now reached the milestone of hundred patients. This trial demonstrates that even in the midst of a challenging outbreak, it's possible to mobilize research rapidly and responsibly.
(01:07)
None of this work is done by WHO alone or the government alone or Africa CDC alone. It's all of us working together as one, but special thanks to the United States and the United Kingdom. The challenge ahead is implementing these interventions at the scale and the speed required to get ahead of the outbreak. And that depends on financing. Of the 518 millionaires dollars required for the Continental Preparedness and Response Plan, 264 million or just over half has been disbursed. We need financing that's timely, impactful, and sustainable. And we also need access and security in the affected areas to ensure the response can operate safely and effectively because, as you know, DRC is marred with active armed conflict.
(02:17)
I would especially like to thank all the health workers who are putting themselves at risk every day to save lives and stop the outbreak. Earlier this week, the government of the United States announced a significant change in its policy for childhood vaccination. Every parent wants to keep their children safe, and vaccines are among the most powerful tools for doing that. WHO is concerned that the changes to immunization policy in the US are not aligned with the best signs. Decades of evidence have shown when children are most vulnerable to disease, when vaccines provide the strongest protection, how many doses are needed, and which vaccines can safely be given together.
(03:20)
That evidence is reviewed continuously as new data emerge from across the globe. And the current evidence is unequivocal. Vaccines, including the MMR vaccine, are safe and do not cause autism. Delaying vaccines or separating doses unnecessarily does not make vaccination safer and can leave children unprotected. Vaccination policy should be guided by rigorous, independent, and transparent review of the best available science and not by political influence.
(04:07)
Finally, today is International Youth Day. Young people are on average the healthiest part of society, but are at particular risk of health threats, including mental health conditions, loneliness, violence, and road traffic crises. Addressing their health needs is essential to achieving health for all. Over the past nine years, WHO has made a concerted effort to include the voices and ideas of young people in our work as part of the WHO transformation. We recognize young people not just as beneficiaries of our work, but as critical partners in achieving global health goals. That's why in 2023, we launch the WHO Youth Council, a network to advise WHO and ensure that youth voices are not only heard, but are instrumental in influencing policy and actions.
(05:19)
Through the Youth Council, WHO aims to co-create solutions that are youth-led, youth-driven, and tailored to their specific health needs. We are committed to capacity building opportunities, including mentorship programs for young people from diverse regions and backgrounds with a particular emphasis on underserved areas. Tarik, back to you.
Tarik Jasarevic (05:50):
Thank you very much, Tedros, for these opening remarks. Before we start with questions, let me just, as promised, tell you who do we have online? And notably, we have colleagues who are in Democratic Republic of the Congo, Dr. Anne Ancia, WHO representative in DRC. We also have Mr. Thierno Baldé, who is Ebola incident manager. So who is leading the response in Bunia. With us is also Dr. Abdirahman Mahamud, who is the Director of Health Emergency Alert and Response Operations. I understand also with us is Dr. Kate O'Brien, Director for Immunization Vaccines in Biological. So all of these colleagues are there to answer your questions. So please, if you have one, just type the icon, raise hand, and we will come to you with this. We will start with the first one. Helen Branswell from STAT. Helen, the floor is yours.
Helen Branswell (06:58):
Thanks very much, Tarik [inaudible 00:07:00]. We'll also probably get back in the queue to ask another question later, but my first question pertains to the Phase 3 trial that is being planned for vaccines in DRC. Can someone please explain to us the way that trial is going to be structured? I take it that as vaccines become available, the trial will start. So Ervebo will probably be the first one in the field. Who are you going to be vaccinating? Contacts of cases? Is it going to be ring vaccination like the Ebola Ça Suffit study? And if so, what are the prospects for success given that the Director General said in his opening remarks that many cases who are discovered dead were never on contact lists? Thank you.
Tarik Jasarevic (08:01):
Thank you very much, Helen. We will start with Dr. Vasee Moorthy, the lead of R&D Blueprint.
Dr. Vasee Moorthy (08:08):
Thank you, Helen, for the question. So I would just like to start by, of course, confirming that any implementation of this protocol will depend on discussion and authorization by all of the authorities that you'd expect to authorize a clinical trial protocol. So we're at the point of being close to submit the protocol to review by DRC regulatory authorities by ethics committees. So all of this really depends on those discussions as would be expected. Where we are right now is that we really have the benefit of many years of working in previous Ebola outbreaks. And as you would know very well, we have the example of Ça Suffit, Ebola Ça Suffit, which was done during the West African Ebola outbreak in 2014 to 2015. So what we're, as WHO, working with Africa CDC, with INRB as the lead biomedical research agency in DRC, and many other partners have done, is convened the leading trial design experts with many representatives from Sub-Saharan Africa to really update the previous successful Ebola Ça Suffit protocol.
(09:23)
So the main update is that it is more efficient to individually randomized before we had ring randomization, but now, the current plan is individual randomization. And secondly, the update is that this is an adaptive protocol. So that means that once we have emerging evidence on the candidates that are being evaluated at the moment, we can add them into this adaptive protocol. So the 31 July TAG report that highlighted the emerging evidence on Ervebo in animal studies showed that it's appropriate to go ahead and prioritize Ervebo, as you said, as the first active arm. So currently, that is what we are proceeding with. We know that both Oxford Serum Institute of India and Moderna are going to be sharing their Phase 1 trial results sometime during September. So if that data supports addition of those Bundibugyo-specific candidates, then they will go into the same protocol.
(10:28)
And you asked who will be enrolled into the trial. So subject to authorization, the plan will be exactly as you suggested. When there is a new case, with the contact tracing team, we identify the contacts of the case. Those individuals are then approached after very extensive community engagement discussions, which of course will happen before the trial where they're approached. And if they're eligible for the trial and they choose to participate in the trial, they will be the ones that are randomized into the trial. Thank you.
Tarik Jasarevic (11:07):
Thank you very much, Dr. Vasee. Hope this answers the question. Let's go to the next one. Our colleague from Geneva Press core, Catherine Fiankan-Bokonga. Catherine, please go ahead.
Catherine Fiankan-Bokonga (11:25):
Yes. Good afternoon, Tarik, and good afternoon to all of you. I have a question regarding the fact that the outbreak began in last February. Was it not formally recognized? Why? Because could this be attributed to symptoms resembling those of malaria or meningit? And now, are the region known to be particularly vulnerable to Ebola able to conduct testing locally in order to detect and confirm cases? And my last question is that I've noticed that some communities are not respecting the protocol. And I'm quite surprised by that as these regions and the communities are used to respect protocols because they faced different outbreaks before and particularly Ebola. How do you explain that? Thank you.
Tarik Jasarevic (12:32):
Thank you very much, Catherine. Let's start with Dr. Chikwe, and then we may see if someone else wants to add from the DR Congo. Dr. Ihekweazu, please.
Dr. Chikwe Ihekweazu (12:41):
Thank you, Tarik. Thanks, Catherine for the question. The DG declared the outbreak a PHEIC on the 15th of May, and we moved very quickly once the information was available and we were sure of what was going on. Further to that, there have been investigations on different pathways on the virus using sequencing and using anthropological studies and really trying to understand why this outbreak was not detected earlier than it was. We were very clear from the very beginning that we were behind the curve and we're dealing with a situation where the outbreak had started a few months before it was formally detected now and confirmed. Now, it's impossible at this date to say exactly when the outbreak started. That's ongoing work. Estimates are two to three months before the declaration of the PHEIC. So we are not in a position to say exactly when it started or all the events that proceeded before that.
(13:54)
We've been very clear on the very difficult circumstances in the Eastern DRC, both in terms of the humanitarian context, the life, socioeconomic circumstances, and everything that led to the spread of this outbreak. Our priority at the moment, of course, is to scale the response. And you would've heard from the DG's remarks on how we are planning to do that over the next few weeks. In terms of adherence to protocols, we have to remember that every outbreak happens in communities. We work with those communities. Life goes on in those communities, socioeconomic activities go on in those communities. So there is no regimented adherence to protocols that can be implemented in the way you might assume. We need to win over the hats and minds of people in those communities. They need to own this outbreak, understand the circumstances that are driving transmission. Most of those circumstances are in families where people are caring for loved ones around funerals where people are showing the loss the way they know, the way they have done in their societies for years.
(15:20)
And these are the things that are leading to an increased risk for transmission of the virus in these communities. So we're working very hard now with the community so that they understand fully what is going on. They own this response and they are open with the healthcare workers that are supporting us to respond to their needs. And that's where we are at the moment. And we have made some progress. We're not on top of this by any stretch of imagination. And we are escalating the response across all the pillars of the response at the moment. And we're hopeful to see some results to that, to our efforts. But at the moment, the message is very...
Dr. Chikwe Ihekweazu (16:00):
... to our efforts, but at the moment, the message is very clear. We are not where we need to be. We need to intensify efforts across board. And the only way we can achieve this is by the community themselves recognizing what we're dealing with, owning the response and working with all the health professionals supporting them.
Tarik Jasarevic (16:23):
Thank you very much. Dr. Chikwe, maybe we can go to DRC and see if Dr. Thierno would like to add something from Bunia if I'm not wrong. Thierno.
Dr. Thierno Baldé (16:39):
Thank you. Thank you. Can you please confirm that [inaudible 00:16:42]?
Speaker 1 (16:44):
Yes.
Tarik Jasarevic (16:45):
Yes, please. Please go ahead.
Dr. Thierno Baldé (16:48):
Can you hear me?
Tarik Jasarevic (16:48):
The sound is not the best, but please go ahead.
Dr. Thierno Baldé (16:52):
Okay. Thank you. And sorry for that. Indeed, I think just to add that we are working here days and night with the different communities, the community leaders. We've been meeting really major parts of the members of the community, starting with the Association of Motorbikes, the Women Association, the leaders which are in town in some villages and to try to have them at the center of this response. This is part of the current scale of that we are doing here in Bunia, but also in all the surrounding localities of Bunia, even beyond the Ituri Province. So, all of the response currently, we are orienting it for trying to have it as a community- centered approach because the communities are at the center.
(17:33)
They are the one who have to drive this response. They are the one who have to tell us exactly what are the needs of the population and to take those needs into consideration for addressing them as much as possible. Therefore, we have the advance to the different response measures. So, this world of the communities is something which is extremely important. We are working with the different partners, supporting the Ministry of Health, going at the lowest level of the health system for engaging those ones. But you have to understand also the changing in the behaviors will not happen really in one day. It's a process, but that process is really improving.
(18:09)
Today, most of the cases are being called to have been reported by the communities and community leaders. As of yesterday, we had a report of some kind of suspected cases in one of the area here which is called Fataki, where we had that call from the community leaders asking for more support. And just to conclude, while we are having those support, definitely as the DG mentioned, having more operational capacities for addressing those ones is something which is extremely crucial and extremely urgent. Thank you and back to you.
Tarik Jasarevic (18:43):
Thank you very much, Thierno. And then we can move maybe to next question. We have Lancet and Paul Adepoju from Lancet. Please, Paul, unmute yourself.
Paul Adepoju (19:01):
Yes, thank you for this opportunity. My question has to do with this. Is WHO putting any consideration into revising the conditions to declare the end of an outbreak? As we saw what's happened in Uganda, at what point should we be considering revising the conditions to declare the end of outbreak? And the peace situation, what impact has it had and what progress have we had regarding ensuring peaceful access for everybody that needs to support in the response? Thank you very much.
Tarik Jasarevic (19:42):
Dr. Chikwe.
Dr. Chikwe Ihekweazu (19:45):
So, thank you very much, Paul. In terms of the declaration of an outbreak over, I guess you are referring to the Marburg case in Uganda. WHO is not considering changing our guidelines with regard to when an Ebola outbreak or Marburg outbreak is declared over. Our policy on that is to declare the outbreak over in any circumstance where we have gotten over two times the incubation period. So, that's 21 days and that's how we arrive at 42 days. The interpretation of the day zero of those 42 days was slightly different in this circumstance. Uganda made the interpretation that the countdown starts from the day of the last local transmission.
(20:49)
Sorry, I mixed up the two outbreaks. We're talking about the Ebola outbreak and the beginning of the countdown in Uganda mixed it up with the case that they were referring to. But anyway, back to the Bundibugyo Ebola outbreak happening in Uganda and the declaration of that over. The principle still is that they counted 42 days from the last case of a local transmission. There was an imported case into Uganda, and we consider that Uganda remains at risk for 42 days after that last imported case. And we will declare from our perspective, the end of the 42 days of follow-up after those 42 days have been achieved from the day of discharge of the imported case.
(21:45)
Whatever the counting starts, whenever it starts and ends, the important thing is that Uganda is on the border of the DRC. There's an ongoing outbreak in the DRC. So, surveillance activities have to remain intensive in Uganda. They have demonstrated that they have the capacity to do this. They've been working very hard, continue to do all aspects of response activities with a lot of intensity. And so, we are fairly confident that Uganda has the capabilities to continue doing the surveillance that they need to do to respond to the outbreak that they have had and to any other important cases that they may find over the next week.
(22:31)
So, the key thing is that as long as that there's an ongoing outbreak in the DRC, Uganda has to continue with its surveillance activities with the same level of intensity. And following the collaboration with us, the visits of our leadership to Uganda over the last few weeks, we see how hard they are working collectively to continue to do this.
Tarik Jasarevic (22:58):
Thank you, Dr. Chikwe. Let's go to next question. I think we have a wire in India and that's Banjot Kaur. Banjot, can you hear us?
Banjot Kaur (23:09):
Yes, I can. Thanks for taking my question. Dr. Tedros said that the contract tracing stands at 80%. I presume this is proportion of those contacts which are known and are in the list, but there would be such contacts which are not known and therefore would not be in the list. And therefore, if we consider this metric, the actual contract tracing percentage may go down. So, I was wondering if we could explain this a bit.
Tarik Jasarevic (23:45):
Yes. Thank you, Banjot. Let's go to our colleagues in DRC. Thierno, would you like to start? And maybe also we can hear from colleagues with you. Thierno?
Dr. Thierno Baldé (24:00):
Thank you so much, Tariq. Am I audible enough?
Tarik Jasarevic (24:03):
Now sound is much better. Thank you very much.
Dr. Thierno Baldé (24:06):
Thank you. Thank you so much. No, thank you very much for the question. I think what is extremely important to mention here is that this outbreak is really occurring in a very complex environment and it's affecting already five provinces in the DRC, which are quite big and very important. So, there is no really a kind of uniformity in this outbreak. We are having five type of outbreaks here with different level of transmission. So, where we see in Ituri, in Central Ituri, where we have Bunia, Rwampara, definitely the transmission is extremely high and probably we are just seeing one part of the outbreak.
(24:43)
And the E4 that we are currently conducting for investigating the cases, but also looking at the contact tracing the contacts, this is ongoing, absolutely. And clearly, we are not seeing all of the cases. However, there are some other localities like if I take the Arua localities which is near to Uganda, you'll know where we are just having few cases and where also we are having some cases coming from Bunia. We are capable of having more than even 80% of the contact tracing. The last cases which happen in Arua are currently... I mean all of the different actions of public health actions were conducted from the investigation of that case, the isolation of the different contacts, but also the provision of care and provision of support to the different contacts.
(25:29)
And we are having 100% of contact follow-up in those areas. And I can tell you with confidence that it's been now three weeks and we're not having any secondary case on those situation. So, there are different patterns that we are seeing here and obviously, we adapt our response strategies to each of these different localities. And just to conclude to mention in areas where we are having these very high level of transmission, as the DG said, we are really focusing mostly on the kind of organizing safe and dignified barriers and to ensure that all of the different suspected and confirmed cases are having the required safe and dignified also obviously treatment care and yes care.
(26:12)
So, this is really the picture that we are having here in the situation. And obviously, the scaling up exercise that we have initiated will allow us to increase again in these different parameters. Over.
Tarik Jasarevic (26:26):
Thank you very much, Thierno. I think this covers the question. Let's go to next one. We have a number of reporters still waiting, so let's make sure that everyone asks one question. Agnes, AFP, Agnes, please go ahead.
Agnes (26:45):
Yes. Hi, good afternoon everybody. Thank you for organizing this briefing. My question concerns Ebola. From what you are saying, it is very clear that the epidemic has not reached the peak. And I was wondering if you have any expectations of that on when do you think that the epidemic could be reached? Thanks.
Tarik Jasarevic (27:11):
Agnes, would it be possible really to repeat the question because the sound wasn't the best to say it mildly. If you can just try one more time.
Agnes (27:23):
Yes. Do you hear me?
Tarik Jasarevic (27:24):
We hear you, but not very well. So, it's very faint.
Agnes (27:30):
Okay. So, I was asking about Ebola and the peak of the epidemic. I understand we are very far from that. When do you think that the peak of the epidemic could be reached? Thank you.
Tarik Jasarevic (27:43):
Okay. So, the question is when we could expect peak of epidemic to be reached. Dr. Chikwe.
Dr. Chikwe Ihekweazu (27:53):
Let's go to the field. Let's take it from Thierno or Abdi and then I can comment.
Tarik Jasarevic (27:58):
Okay. Let's go to Dr. Abdi and Thierno in DRC.
Dr. Abdi Rahman Mahamud (28:09):
I'll start. It's Abdi. Thank you so much to the question. In terms of the peak of the outbreak, we have to see this is not a homogeneous outbreak. As Thierno and DG illustrated every region, whether it's Central Ituri, Bunia, Rwampara, we are yet to see the peak of the outbreak. In areas where the outbreak has started like Mongbwalu five months ago or six, seven months ago, we are seeing now going down. The bed capacity right now is almost 20%, 30% there. So, each region, unless we address the hotspot, which is Bunia and the greater Bunia, we'll be seeing wave and wave.
(28:51)
So, for currently on terms of planning under the government leadership, we are planning for six months, but we are conscious, and that's the moderate scenario. There's a worst case scenario where this outbreak may last nine months to 12 months. We are doing everything possible to shorten that and do and interact within the next six months. Having said that is a highly dynamic outbreak. And unless, as DG said, we have the community on our side will be struggling. The last previous outbreak, which happened in a security compromise lasted about two years. We don't want to repeat of that.
(29:27)
And under the leadership of government, we are doing everything possible to reduce that and hopefully in the next six months, but hope it's not a strategy. We have to have the community on our side, increase the surveillance, increase our safe and scalable care, save and dignify by all the component of the response. If they go at the same time across the five transmission zones, we are expecting a turnaround in three months. But that requires an international solidarity and a significant funding. DG mentioned 3000 beds. It took us another three months and a half months to reach around 1000. That's significant investment, significant HR will require global solidarity. Thank you.
Tarik Jasarevic (30:13):
Thank you very much, Dr. Abdi. Let's move on then. We have Bloomberg, Ashleigh Furlong. Ashleigh, please go ahead. Do we have Ashleigh online? If not, well, Ashleigh, try again. We have Priti Patnaik from Geneva Health Files. Priti.
Priti Patnaik (30:53):
Good afternoon. Thank you for taking my question. I was wondering if you can comment on the possibility of the virus mutating and hence contributing to a wider outbreak than initially expected. Do you already have more information on this? And a second quick one on financing, Africa CDC has said in their briefings that the financing would make most sense if it is used at the source. Maybe you could elaborate on how the financing is being deployed right now. Thank you so much.
Tarik Jasarevic (31:36):
Thank you very much, Priti. Maybe Dr. Dr. Briand can start on the first part of the question.
Dr. Sylvie Briand (31:48):
Thank you very much for this question. And so, indeed there are studies ongoing and to study the virus when we have the samples and when it's possible, but so...
Dr. Sylvie Briand (32:00):
... The samples and when it's possible. But so far we have not seen any mutation on this virus. And probably the course of the outbreak is currently much more explained by the context in which the virus is circulating, which is an area of conflict with a lot of population mobility, very difficult situation in the ground, and a lot of difficulties, in fact, to break chain of transmission because of the social and economic context in this part of DRC. So of course we are continuing to monitor the virus because it's an important part of the outbreak. But so far it's not the reason why we see so many cases. It's more the fact that the outbreak is ongoing and so far we haven't had enough resources and enough capacities to really contain the spread. Thanks.
Tarik Jasarevic (33:16):
Thank you very much, Dr. Briand. I think there was another part of the question on financing, if anyone can address financing issue.
Dr Chikwe Ihekweazu (33:31):
I can just quickly say that of the response plan altogether, about 50% of it is funded at the moment for the response. We really need everyone to come together to continue to support the work that we're doing. The first strategic response plan was launched a few months ago now. At the beginning of the outbreak, the outbreak has continued. We need to intensify our efforts. So thanks to everyone and all the countries, all the donors that have come together in solidarity to support the response. We've made the very best use of the resources available and we continue to. But now that it's become clear that we need to scale the response, we're thinking about two to three times the scale of the response at the moment. We need to firstly make sure that all the pledges that have been made are actually fulfilled. And secondly, to look towards the future in order to get ahead of this.
(34:37)
So those are the comments I have at the moment. We're about 50, 60% funded and we need the resources to continue doing the important work we're doing.
Tarik Jasarevic (34:47):
Thank you, Dr. Chikwe. Dr. Anne Ancia, WHO representative of the IRC would like to add something.
Dr Chikwe Ihekweazu (34:53):
Good.
Dr. Anne Ancia (34:55):
Yes. Good afternoon, yes. And I'm just coming from a three hours meeting with the Ministry of Health when we discuss planning very, very much. So as you know, the first national plan in the IRC for the first three months of the response, so the plan is actually ending in three days exactly. The first plan was budgeted at 240 million. The new plan, looking at the new reality that we've got, and you heard it, a tremendous need for scale up and a longer term to be able to control the outbreak, the new plan that has been presented by the government, and it's almost finalized, it's not yet, it's 940 million. But this is a plan now that doesn't look only on the Ebola response, but take a significant additional look at as well the continuity of health services. I am just coming from Bunia when I was there with my regional directors, Dr. Mohamed Janabi, and I was there of course with all the colleague from WHO who are on the field, Dr. [inaudible 00:36:07], as well as Dr. [inaudible 00:36:09] who are here today.
(36:10)
We heard very much from the community they appreciate tremendously the support that is given to contain the outbreak and to save the majority of life of people dying from Ebola. But they also ask us very much, they said, " We are also dying from diarrhea. Our family are dying from diarrhea because there is no water. Our family are dying from acute respiratory infection." When we were visiting the Lita Ebola Treatment Center, we saw a death there. It was not a death from Ebola. It was a death of a woman who died during hemorrhage intrapartum. And well, it was not an hemorrhage intrapartum, it was a bad presentation of a baby. So she died from lack of blood.
(37:04)
And therefore the communities are asking us not only to care of the Ebola outbreak that is affecting the population, but also to care of the other extremely necessary health services that they need to address the other cause of death in the community. And the plan that is now worked on and is being presented by the Minister of Health will include as well the essential health services. And it's why also it is increasing. The rest of the question was who is financing the plan? The question was, why is the plan not finalized at its source? So for the time being, it is true that most of the funding has been given to the, well, partners and non-health partners who are working in Ebola and in other outbreak response. So of course WHO, UNICEF, we've got OCHA because of course we're working in a [inaudible 00:38:06] humanitarian situation.
(38:08)
You've got UNFPA, you've got Africa CDC, and you've got many, many non-governmental organization, MSF, International Medical Corp, ALIMA, and so on and so forth. So it is true that the government has been asking, they say they have received very little direct financing. And there is a discussion that is ongoing actually because the government would like, for example, to pay the health professional themself. They want to pay all the medical doctors, they want to pay all the nurses. And there is an ongoing discussion so that the government could really pay by themself. It will be a part domestic financing from them, but also even to add support from donors and that they will take the responsibility to pay themself the salary, but also the prime of the health professional. So there will be probably a shift in having a part being paid by the government of DRC.
(39:11)
I want to say that the government of DRC has already invested 50 million in the actual response, but they will also eventually increase their part in really paying particularly the health professional that are working in the province of Ituri. Over.
Tarik Jasarevic (39:28):
Thank you very much Anne. Good to hear from you. I understand that Dr. Abdi would like to add something, and I think it was on the first part of the question. Dr. Abdi.
Dr. Abdi (39:40):
Thanks, Tarik. It was about the pathogen, if it's mutated, all viruses do have mutation and virologists are studying. But I want to put in, is the context where the outbreak is happening and the response capacity. The incredible amount of work done in Uganda, but also in our clear issues. If we act fast, we'll be able to interrupt the transmission. And the science will collect epidemiological data, clinical data on severity, on transmission, on all the aspect. But we have a chance we can interrupt and we have clear evidence both from Uganda and also from DRC. Timely interventions at scale will lead to interruption of this transmission.
Speaker 2 (40:22):
Just maybe Tarik, to add on the component around really, again, the engagement of the communities as we're saying, as far as we are doing now, I mean really having them at the center of this exercise. And as Anne was mentioning, addressing also the older basic needs just beyond Ebola, I think disease can be really a kind of game changer. We are operating in a very weak health system. It has to be, I mean, said, in a very fragile health system. So where access to blood, access to medicine, access to primary healthcare services is extremely needed. So it's really important to bring those different elements together to have therefore at the end, the adhesion and the agreement and the support of the communities. Therefore, for them to see us as really responders caring for their own wellbeing, but beyond also the Ebola, for the older health needs, but at the same time also the older social and basic needs.
(41:20)
Thank you.
Tarik Jasarevic (41:23):
Thank you. [inaudible 00:41:24] thank you. Abdi, we have time for two more questions. Let's try Kemi Osukoya, Africa Bazar Magazine. Kemi, can you hear us? If you can, please unmute.
Kemi Osukoya (41:37):
Hi.
Tarik Jasarevic (41:38):
Yes. Go ahead, please.
Kemi Osukoya (41:39):
Yeah. Okay. Thank you very much for taking my question. Good afternoon. First of all, I wanted to confirm, the U.S. announced last week that it will provide $242 million for the ongoing Ebola response. Could you confirm whether that fund has been received and how you plan to distribute and use that fund? My other question is, in listening to the remarks from the executives earlier, it sounded like you are blaming the communities for lack of trust, for using their traditional practices and for socioeconomic issues that they're facing rather than the incompetency of the DRC government. I just want clarification regarding that because this is not the first Ebola or the second Ebola or the third Ebola. And until the Director General returned back to DRC recently, I've been following this since it was since May. I've never seen the DRC president travel to this community to go and talk to these people that are impacted by the Ebola.
(43:20)
But during election year, they often go to this community to get votes. And as one of your executives said, the issue, they're dying not just from Ebola, there are other health issues that are being affected. So could you talk a little bit about the conversation that you are having with the government, especially the president, the head of the state? What conversation are you having for him to build that trust within the community to show that they care rather than just caring about the vote? Thank you very much.
Tarik Jasarevic (44:08):
Thank you very much, Kemi, for these questions. There are a number of them. I really don't think that anyone blamed the community here, but who would like to start? Maybe Dr. Chikwe.
Dr Chikwe Ihekweazu (44:24):
I'm sure Director-General will have something to say at the end. Firstly, Kemi, thanks a lot for your questions. We're very grateful for the general support of the U.S. government for the response altogether. They have their mechanisms of dispersing funds to implementing organizations in different areas contributing to the response. Those resources don't come to WHO through WHO. So we wouldn't be in a position to comment about the distribution of those resources. On the second part of your question, in an outbreak response, we never blame anyone. There are very many circumstances that lead to the emergence and re-emergence of infectious diseases. Some of them relate to the virus, some relate to the community, some relate to the context. And in responding to any outbreak, we work on all of those [inaudible 00:45:27]. We work on the virus, and you would've had some of those results spoken about and discussed on possible mutations, on sequencing and the information we can learn from that.
(45:39)
We've spoken about the very difficult context that we're working on in the Eastern DRC, a very difficult humanitarian context that has been going on for many years, challenging access, security, just fiscal access to many of the locations. But we've also always spoken about the vibrant communities that we have seen, worked with, continue to work with. And basically we have a large team in all those areas working with the community. There's no other way of responding to an outbreak of this scale without working with the communities. So our most important target at the moment is to stop transmission. Transmission doesn't happen anywhere outside of the communities. They happen in households, like I said, they happen during funerals. They happen in healthcare settings where appropriate infection prevention and control is not happening. So the only way we can interrupt transmission is by working with the communities. In fact, we will achieve success when the committees own the response.
(46:48)
So this is not about blaming them. This is about really stating exactly how a successful response will happen. This is how all the previous Ebola responses have been turned around. They've been turned around when communities engaged with the challenges, took it up and led the response. So that's really where we're heading towards. We've seen an incredible amount of progress over the last few weeks. We've seen leaders of communities come forward, the religious leaders, women leaders, leaders of youth organizations come forward and take increasing ownership of the response. So really my comments were actually to really recognize the role of the community, recognize the engagement, recognize their work, and continue to encourage everyone working to acknowledge this and support them in the work that they're doing with our support. And also recognize the role of government, their leadership. None of us can go into any country to drive a response without the sovereign government owning it and leading it.
(48:02)
And so we're working very closely ...
Dr Chikwe Ihekweazu (48:00):
... government owning it and leading it. And so we're working very closely supporting the government of the DRC in this response. So it's neither one or the other. It's really everyone coming together. The community, the government, WHO, and all our partners are working towards the same targets. And if we continue to work very hard, increase the intensity of our work, which we are doing at the moment, but really increase the ownership of the community in this response, then we will have a chance of succeeding.
Tarik Jasarevic (48:37):
Thank you very much. Thank you very much, Dr. Chikwe. And we will go back to Helen Franceville before we close this briefing as she has a follow-up question and it's always a pleasure to have her with us. Helen, please go ahead.
Helen Branswell (48:55):
Thank you very much, Tariq. I think this would probably go to Dr. O'Brien if she's still on the line. In the Director General's opening comments, he talked about the executive order from the US government, the president, making recommendations for changes to vaccine policy in the United States. One of the things he particularly stressed was the desire to have combination vaccines, MMR for a start, but others after broken up back into their individual components. And I would like to hear Dr. O'Brien's thoughts about that. Thank you.
Tarik Jasarevic (49:34):
Thank you, Helen. We have also Gitte here, but Kate, as you were asked, would you like to start or we give the floor to Gitte? Whatever you prefer. Gitte, why don't you start and maybe Kate can add?
Birgitte Giersing (49:55):
Yes, thank you. Hello. Hello, Helen. Thank you for the question. Yes. We are actually extremely supportive of the continued combination of measles, mumps, and rubella. The number of countries that currently introduce a combination vaccine is the great majority. There are out of 194 member states, 179 of those actually use the combination vaccine. Only 15 countries currently use the monovalent. And our concern about the breakup of combination vaccines is that these would then actually be far more difficult to deliver. At the moment, the MMR schedule is a two-dose schedule with those three vaccines. And if we break that up, that obviously is multiple vaccines within the schedule that would actually increase the number of injections and the complexity of the schedule.
(51:16)
We have extensive scientific evidence that combination vaccines are safe and effective. They enable us to reach populations because we have multiple vaccines within a single shot. They are more acceptable generally to communities, and they really simplify the delivery of vaccines, particularly in the childhood immunization system. So we're very supportive of combination vaccines. There is a lot of evidence to support their safety, effectiveness and acceptability.
Tarik Jasarevic (52:05):
Thank you. Thank you. Thank you, Gitte. Dr. Farrar, would you like to add something?
Jeremy Farrar (52:10):
Yeah, thanks very much. Helen, good to hear from you. Just to underline some comments made there by Gitte. Helen, I think you've really got to look, as you've done many times, at the extensive evidence behind these vaccines, including evidence extensively from experts in the United States. Decades of experience using these vaccines saved countless lives around the world, 59 million lives around the world saved from measles in the last 20 or so years. 1.1 million people's lives saved by vaccination in the United States over the last 25, 30 years. It's an incredible public health story. We also know that at the moment in many countries, including the United States, there are extensive measles outbreaks, which are causing huge concern. And we should also remind ourselves that these three diseases are not mild diseases. They have severe complications. If anybody has seen a child post-measles with encephalitis, you remember it for the rest of your life. These are not mild diseases.
(53:19)
The evidence base is enormous and the evidence base for the adverse events, there are adverse events. There are fevers, yes, there are even sometimes very rarely fits, but the risk of not having the vaccination is hugely bigger than the benefits that accrue from the vaccination for individuals and the communities they're in. So the evidence base is there, the diseases are severe. And if you break up these vaccines and force people to go back with their children to six or seven clinics to get a series of vaccines, the reality is many will not return for those subsequent vaccines and children at their most vulnerable stage for these diseases will get infected. Some of them will go to hospital and tragically some of them will die of what is a preventable disease.
(54:08)
So yeah, we are very concerned. WHO provides the global evidence for these vaccines through the SAGE committee. Individual countries, of course, make their own decisions about which policies to implement, but we call on all countries to use the evidence-based, use WHO's advice and guidance, and make the best policy decisions based on the scientific evidence, not on political interference.
Tarik Jasarevic (54:32):
Thank you, Dr. Farrar. And Dr. Bryan would like to make one point as well. Dr. Bryan, welcome.
Dr. Bryan (54:39):
Yeah. I just want to supplement by saying that anything that is done that makes it harder for a parent to get the vaccines that kids need to protect them from what are serious diseases, anything that's done to make that harder is not in service of the benefit of the child, nor is respecting the many, many things that parents are busy doing in their daily lives to care for their families and their homes, their communities, the work that they do. I think the other thing to point out here is that in the US, there aren't vaccines that are of the separate three antigens. And so this, from a very practical perspective, it's not possible to do this at this point.
(55:26)
And then I think the third point just to make is that all we have to do is look at the outcry from around the world. There are pediatricians, there are vaccine experts, there are epidemiologists. I think when you look in the media, there has been an outcry around this. This is going in exactly the wrong direction, and there is no evidence that would drive this decision. It's not in service of the benefit to children. It's certainly not in service of improving access to vaccines. And for many people, they want the vaccines, but the difficulty they have in the time when clinics are available, the number of visits that they're making, just the convenience aspect.
(56:14)
So this is something that from decades of experience, we know that the more you can enable families to be able to do what they want to do, the higher the coverage is and the protection of children. So this is not in service of any of those things. And there's certainly no scientific evidence that is driving this. Thanks.
Tarik Jasarevic (56:39):
Thank you, Kate, Gitte, and Jeremy for addressing this question. With this, we will close this press briefing. And for the journalists who are sending us questions in writing, our friend Dragana from ABC, we will try to send you some answers back. As always, we will send the recording of this press briefing in the next hour or two. I give the floor to Dr. Tedros for his closing remarks.
Tedros Adhanom Ghebreyesus (57:07):
Yeah. Thank you, Tariq. Thank you to all members of the press for joining us today, and see you next time.